Provider Demographics
NPI:1629027636
Name:BRYSON, MICHAELE ANN (LPC)
Entity Type:Individual
Prefix:MS
First Name:MICHAELE
Middle Name:ANN
Last Name:BRYSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1416
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76241-1416
Mailing Address - Country:US
Mailing Address - Phone:940-665-8056
Mailing Address - Fax:940-665-8057
Practice Address - Street 1:207 S. DIXON STREET
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240
Practice Address - Country:US
Practice Address - Phone:940-665-8056
Practice Address - Fax:940-665-8057
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6541101YP2500X
TXL.P.C.6541101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTPI154260702Medicaid
TX154260701Medicaid